The percentage of women, who did not obtain prenatal care until after the third month of their pregnancy or had no
prenatal care at all, improved from 25% in 1989 to 18% in 1997. Women who receive delayed or no prenatal care are at-risk for having undetected
complications of pregnancy, preterm delivery, and low birthweight babies. Despite the overall positive trend, racial and ethnic disparities in
prenatal care persist. In 1997, black and Hispanic women were still twice as likely as white women to have delayed or no prenatal care. A survey
of 13 states found that more than half of the women with delayed or no prenatal care would like to have had care earlier. Early prenatal care is
a cornerstone of safe motherhood programs, and it is important to monitor changes in access to care, better understand the barriers to care, and
develop appropriate health services for women.

Scombroid Fish Poisoning — Pennsylvania, 1998

Scombroid poisoning has been associated primarily with eating contaminated tuna, mahi-mahi, and
bluefish.

PRESS CONTACT:Eileen Dunne, M.D.

CDC, National Center for Infectious Diseases(404) 639–2206

In December 3, 1998, four adults became ill after eating tuna-spinach salad at a restaurant in Pennsylvania. Test results,
made on a sample of the remaining fish, were consistent with scombroid poisoning. Symptoms include a burning sensation in the mouth, a metallic
taste, facial blushing, nausea, diarrhea, sweating, and headache. Scombroid poisoning is caused by histamine and other products produced by
certain bacteria on some types of fish. From 1988 to 1997, there have been 145 outbreaks of scombroid poisoning reported to CDC; however, many
cases probably are not reported. The fish implicated in this outbreak were caught by the long line method of fishing; retrieval may take up to
12-14 hours and fish may be retained on lines up to 20 hours. Conditions allowing histamine production could have occurred while the fish were
in warm water suspended on the long line.